Objective

Advances in developmentally sensitive measurement have enabled differentiation of normative versus clinically salient irritability in early childhood. However, clinical application of these measures is still nascent. The authors developed an optimized model of clinically salient irritable behaviors at preschool age. Based on this model, the authors derived an empirically based cutoff in relation to concurrent DSM-5 irritability-related disorders (i.e., oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) and used longitudinal models to test the predictive validity of the cutoff for impairment and irritability trajectories and later DSM disorders.

Method

Preschool children oversampled for irritability were followed over 3 time points into early school age (N = 425; mean age at baseline 4.7 years, mean follow-up 2.9 years). Mothers reported on children’s irritability using the developmentally validated Multidimensional Assessment of Profile of Disruptive Behavior (MAP-DB) Temper Loss scale, impairment using the Family Life Impairment Scale, and DSM categories using the Preschool Age Psychiatric Assessment and the Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version.

Results

Of 22 MAP-DB Temper Loss behaviors, 2 behaviors—1 normative (easily frustrated) and 1 rare dysregulated (destructive tantrums)—were uniquely related to cross-domain impairment. At baseline, these 2 irritability items identified diagnostic status (oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) with good sensitivity (70–73%) and specificity (74–83%). Children above the irritability cutoff at baseline also exhibited more persistent irritability and impairment and greater likelihood of DSM disorders in early school age.

Conclusion

Clinical identification of early-onset irritability can be enhanced using brief, developmentally optimized indicators. Further research to apply these findings to tiered early intervention is important.

中文翻译：

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识别幼儿期的临床上明显的烦躁

客观的

对发育敏感的测量技术的进步已使儿童早期的标准易怒性和临床上的易怒性得以区分。但是，这些措施的临床应用仍处于初期。作者开发了一个学龄前临床上明显的烦躁行为的优化模型。基于该模型，作者得出了与并发DSM-5易激惹相关疾病（即对立违抗性疾病，破坏性情绪失调性疾病，其他抑郁性疾病）相关的基于经验的临界值，并使用纵向模型测试了该模型的预测效度。障碍和易怒轨迹以及后来的DSM障碍的临界值。

方法

在3个时间点之前对易怒性进行过高采样的学龄前儿童被纳入早期学龄期（N ​​= 425；基线时的平均年龄为4.7岁，平均随访时间为2.9岁）。母亲使用发展得到验证的破坏性行为特征量表（MAP-DB）脾气损失量表，家庭生活障碍量表进行的损伤以及学龄前儿童精神病学评估以及情感障碍和精神分裂症的时间表中的DSM类别，报告了儿童的易怒性。–当前和终身版本。

结果

在22种MAP-DB脾气流失行为中，有2种行为与跨域损伤独特相关，其中1种行为为规范性（容易受挫）和1种罕见失调（破坏性发脾气）。在基线时，这两个易怒项目以良好的敏感性（70-73％）和特异性（74-83％）确定了诊断状态（对立违抗性疾病，破坏性情绪失调性疾病，其他抑郁性疾病）。在基线时高于易怒极限的儿童还表现出更持久的易怒和障碍，并且在学龄早期出现DSM障碍的可能性更大。

结论

可以使用简短的，经过发展优化的指标来增强对早期发作性烦躁症的临床识别。将这些发现应用于分层早期干预的进一步研究很重要。